Non-Hodgkin lymphoma

Last revised by Rohit Sharma on 4 Aug 2023

Non-Hodgkin lymphoma (NHL) is a neoplasm of the lymphoid tissues originating from B cell precursors, mature B cells, T cell precursors, and mature T cells. It includes all types of lymphomas apart from Hodgkin lymphoma.

See the WHO classification of haematolymphoid tumors for further information on subtypes. 

Up to two-thirds of patients present with peripheral lymphadenopathy.

Approximately half of patients develop extranodal disease (secondary extranodal disease) during the course of their disease, while between 10-35% of patients have primary extranodal lymphoma at diagnosis.

Less common presenting symptoms include:

  • skin rash

  • increased hypersensitivity reactions to insect bites

  • generalized fatigue

  • pruritus

  • malaise

  • fever of unknown origin

  • ascites

  • effusions

Symptoms of primary gastrointestinal (GI) tract lymphoma include:

  • nausea and vomiting

  • aversion to food

  • weight loss

  • fullness of the abdomen

  • early satiety

  • visceral obstruction-related symptoms

  • features of acute perforation and gastrointestinal bleeding

  • features of malabsorption syndrome

Symptoms of primary central nervous system (CNS) lymphoma include:

  • headaches

  • features of spinal cord compression

  • lethargy

  • focal neurologic deficits

  • seizures

  • paralysis

Management is highly variable depending on the exact type and staging of non-Hodgkin lymphoma, but generally, management options include:

  • chemoimmunotherapy

    • e.g. regimens such as R-CHOP (rituximab + cyclophosphamide + doxorubicin hydrochloride + vincristine + prednisolone) for some types of diffuse large B-cell lymphoma

    • e.g. regimens such as R-CODOX-M/IVAC (rituximab + cyclophosphamide + vincristine + doxorubicin + high-dose methotrexate, alternating with ifosfamide + etoposide + cytarabine) for some types of Burkitt lymphoma

  • radiotherapy

  • hematopoietic stem cell transplant

    • usually only in refractory disease

  • chimeric antigen receptor (CAR)-T cell therapy

    • usually only in refractory disease

Management options for non-Hodgkin lymphoma is a very dynamic field, with many new and trial/experimental therapies being utilized.

Non-Hodgkin lymphoma can be divided into two groups, "indolent" and "aggressive", based on the prognosis.

Indolent lymphoma:

Aggressive lymphoma:

  • often associated with non-specific B symptoms such as weight loss, night sweats, and fever, and can result in death within a few weeks if untreated

  • e.g. diffuse large B cell lymphoma (DLBCL), Burkitt lymphoma, precursor B and T cell lymphoblastic leukemia/lymphoma, adult T cell leukemia/lymphoma, and certain other peripheral T cell lymphomas

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